Resuscitative Endovascular Balloon Occlusion of the Aorta: An Emerging Role for Interventional Radiology in Trauma

Purpose: To review the utility of resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method of controlling hemorrhage in the acute setting, as well as examine the current literature, treatment outcomes, and future therapies.

Materials and Methods: REBOA is a method of controlling hemorrhage in the acute setting. The REBOA device is designed to be a minimally invasive, expeditious, and temporary means of to bridge to definitive endovascular or surgical management. A 2018 joint statement by the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians stated that REBOA should only be placed by an acute care surgeon, an interventional radiologist, or a vascular surgeon trained in use of REBOA. A multidisciplinary approach to REBOA involving endovascular specialists can advance research, patient care, and management of acute hemorrhage in the trauma setting. In this exhibit, a case-based review as well as exploration of the literature and current evidence will be used in examining the utility of REBOA in the interventional radiology setting.

Results: This educational exhibit will (1) review the clinical management of hemorrhagic shock, including medical, interventional, and surgical techniques for treatment; (2) provide a case-based review of REBOA-amenable hemorrhage (traumatic and iatrogenic abdominopelvic hemorrhage, ruptured abdominal aortic aneurysm, severe postpartum hemorrhage, and severe gastrointestinal bleeding); (3) present the role of REBOA and associated current endovascular techniques and technical pearls; (4) review the procedural indications, contraindications, and potential risks; and (5) review the present literature, treatment outcomes and prognosis, and future therapies.

Conclusions: After reviewing this exhibit, the viewer will gain a better understanding of the management of emergent hemorrhage, including the initial clinical diagnosis and management with special focus on REBOA, endovascular techniques, and technical pearls, as well as current treatment outcome data and future therapies.